Parental observations and perceptions important in detecting sleep problems in children

A new study from the University of Rochester has found that parental observations and perceptions of their childrens' sleep habits are a valuable supplement to objective laboratory tests in detecting obstructive sleep apnea (OSA).

The study tracked 151 overweight children and adolescents to learn whether an overnight sleep test or simple parent-report questionnaire of their child's sleep symptoms would better predict kids' physical, emotional, social and academic quality of life. Researchers chronicled the severity of the participants' sleep troubles by monitoring brain waves, eye movements and muscle tone to pinpoint different stages of sleep, and to separate sleep from wakefulness. With video cameras and microphones, they captured stirring and snoring; they also tracked body movements, heart rate, oxygen and carbon dioxide levels, breathing effort and airflow.

Despite the test's ability to accurately diagnose sleep disorders, the lab reports could not predict kids' quality of life. But parental reports did, thanks to simple survey questions such as “Are you concerned about your child's sleep?” and “Does your child stop breathing during the night?” The overweight children in the study with symptoms of OSA had a lower quality of life both by their report and parental report. Objective measures of OSA did not correlate with quality of life.

“It could be that certain symptoms – things parents might instinctively notice, but that we might not routinely test in the lab – are to blame for hindering these children's well-being,” said Margaret-Ann Carno , Ph.D., M.B.A., R.N., D., A.B.S.M., assistant professor of Nursing and Pediatrics at the University of Rochester School of Nursing and the study's main author. “Parents seem to know when the problem has worsened and begins affecting other aspects of their child's life.”

For example, based on the quality of life surveys, which were completed both by parents (reporting their perceptions of their children's experience) and by children (reporting for themselves), it's clear that even youth with only mild forms of obstructive sleep apnea – that is, kids whose lab tests show they only very briefly pause their breathing – might be suffering more negative impact to their health and well-being than sleep experts ever appreciated in the past.

One symptom that was particularly alarming to parents was snoring. Previous studies have reported that snoring is especially common in overweight kids, whose extra fatty tissue both narrows the airway and vibrates when the child inhales. And, while it may seem cute, funny or benign, snoring alone carries a fleet of negative heath consequences. Sleep studies are a necessary part of an evaluation for snoring, particularly in overweight children who do not respond well to standard interventions like removal of the tonsils and adenoids.

Carrying too many extra pounds can inflict a serious psychological toll on kids. Previous studies show that overweight children and teens are already more likely than their healthy-weight peers to cultivate a negative self-image, display hopelessness, view themselves as poor students, attempt suicide, suffer socially and spend less free time with friends.

And since poor sleep affects the body's sense of hunger, it's thereby linked to greater risk for a child's being overweight; and, as previously described, extra weight in turn impairs sleep, beginning a vicious cycle.

“Analyzing these cases isn't a far cry from the ‘chicken and egg' conundrum,” said co-author Heidi Connolly , M.D., associate professor of Pediatrics and Psychiatry, who manages the Pediatric Sleep Center at the University's Golisano Children's Hospital. “We're asking how being overweight, sleep problems, and poor quality of life all cause and are caused by each other. Which one, if reversed, would most quickly improve the other two? That's hard to say.”

“Still, sleep studies have proven extremely valuable in diagnosing and treating an array of sleep disorders from sleep apnea to restless leg syndrome,” Connolly added. “What this study tells us is that the anecdotal observations of parents and caregivers are among our best resources for understanding how the data collected in our studies impacts children's day-to-day lives.”

The study is published in the April edition of the Journal of Pediatric Psychology.